Andrea Maculano Esteves

O exercício físico e os aspectos psicobiológicos

Physical exercise and the psychobiological aspects The objective of this review is to address part of the studies on an issue not much explored: the relation between physical exercise and the psychobiological aspects. The importance of understanding these aspects and how they affect the quality of life of the human being is what stimulates researches on this issue. The literature stresses the fact that the regular practice of physical exercise produces positive results not only regarding sleep and its possible disorders, but also regarding the psychological aspects and the mood disorders, such as anxiety and depression, and the cognitive aspects, such as memory and learning. However, there are individuals who engage in the practice of physical exercise with such intensity and/or frequency, or yet, who make use of illegal drugs that can bring harmful effects to their health, as the case of physical exercise dependents and anabolic steroids users. Physical exercises cause physiological, biochemical and psychological alterations and, therefore, may be considered as a non-medication intervention for the treatment of disorders associated to the psychobiological aspects.

Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury

Study design: Randomized controlled trial of physical exercise and dopaminergic agonist in persons with spinal cord injury and periodic leg movement (PLM).Objective: The objective of the present study was to compare the effectiveness of physical exercise and of a dopaminergic agonist in reducing the frequency of PLM.Setting: Centro de Estudos em Psicobiologia e Exercício. Universidade Federal de São Paulo, Brazil.Methods: A total of 13 volunteers (mean age: 31.6±8.3 years) received L-DOPA (200 mg) and benserazide (50 mg) 1 h before sleeping time for 30 days and were then submitted to a physical exercise program on a manual bicycle ergometer for 45 days (3 times a week).Results: Both L-DOPA administration (35.11–19.87 PLM/h, P<0.03) and physical exercise (35.11–18.53 PLM/h, P<0.012) significantly reduced PLM; however, no significant difference was observed between the two types of treatment.Conclusions: The two types of treatment were found to be effective in the reduction of PLM; however, physical exercise is indicated as the first treatment approach, while dopaminergic agonists or other drugs should only be recommended for patients who do not respond to this type of treatment.

Relationship between the quality of life and the severity of obstructive sleep apnea syndrome

The effects of sleep disorders on the quality of life (QOL) have been documented in the literature. Excessive sleepiness and altered circadian rhythms may negatively affect ability to learn, employment, and interpersonal relations, and directly degrade QOL. The objective of the present study was to evaluate the impact of obstructive sleep apnea syndrome of varying severity on QOL. The study was conducted on 1892 patients aged 18 years or older referred by a physician to the Sleep Institute, São Paulo, with complaints related to apnea (snoring, excessive daytime sleepiness, hyperarousal, and fatigue). They were submitted to overnight polysomnography for the diagnosis of sleep disorders from August 2005 through April 2006. The patients completed the Epworth Sleepiness Scale and QOL SF-36 sleep questionnaires. They were classified as non-physically active and physically active and not-sleepy and sleepy and the results of polysomnography were analyzed on the basis of the apnea hypopnea index (AHI). The apneic subjects showed a reduction in QOL which was proportional to severity. There was a significant decrease in all domains (physical functioning, role physical problems, bodily pain, general health perceptions, vitality, social functioning, emotional problems, general mental health) for apneics with AHI >30, who generally were sleepy and did not participate in physical activities (P < 0.05). The present study provides evidence that the impact of sleep disorders on QOL in apneics is not limited to excessive daytime sleepiness and that physical activity can contribute to reducing the symptoms. Thus, exercise should be considered as an adjunct interventional strategy in the management of obstructive sleep apnea syndrome.

Exercise training improves sleep pattern and metabolic profile in elderly people in a time- dependent manner

Aging and physical inactivity are two factors that favors the development of cardiovascular disease, metabolic syndrome, obesity, diabetes, and sleep dysfunction. In contrast, the adoption a habitual of moderate exercise may present a non-pharmacological treatment alternative for sleep and metabolic disorders. We aimed to assess the effects of moderate exercise training on sleep quality and on the metabolic profile of elderly people with a sedentary lifestyle. Fourteen male sedentary, healthy, elderly volunteers performed moderate training for 60 minutes/day, 3 days/week for 24 wk at a work rate equivalent to the ventilatory aerobic threshold. The environment was kept at a temperature of 23 ± 2°C, with an air humidity 60 ± 5%. Blood and polysomnographs analysis were collected 3 times: at baseline (1 week before training began), 3 and 6 months (after 3 and 6 months of training). Training promoted increasing aerobic capacity (relative VO2, time and velocity to VO2max; p < 0.05), and reduced serum NEFA, and insulin concentrations as well as improved HOMA index (p < 0.05), and increased adiponectin levels (p < 0.05), after 3 months of training when compared with baseline data. The sleep parameters, awake time and REM sleep latency were decreased after 6 months exercise training (p < 0.05) in relation baseline values. Our results demonstrate that the moderate exercise training protocol improves the sleep profile in older people, but the metabolism adaptation does not persist. Suggesting that this population requires training strategy modifications as to ensure consistent alterations regarding metabolism.

Occurrence of limb movement during sleep in rats with spinal cord injury.

Several studies have shown the occurrence of Periodic Leg Movement (PLM) in spinal cord injury patients. The aim of this study was to identify the occurrence of limb movements during sleep in spinal cord injury rats and the possible involvement of the spinal cord in causing these movements. The animals were allocated to spinal cord injury (SCI) and SHAM groups. The two groups were submitted to surgery and electrodes inserted to analyze sleep patterns (electroencephalogram-ECoG) and muscular activity patterns (eletromyogram-EMG). After baseline sleep recording (24 h), the spinal cord injury surgery (level T9) was performed on the SCI group rats and sleep was recorded for seven consecutive days. After spinal cord injury, 10 of the 11 rats began to present limb movements during sleep, while the SHAM group showed no limb movements during the 8-day sleep-recording period. In relation to sleep efficiency, the SCI group presented alterations during the first few days after spinal cord injury but returned to normal values at the end of the 7-day experimental period. The data suggest that spinal cord injury rats may be used as models to study PLM in paraplegic patients, and that these movements may be generated in the spinal cord itself, without the involvement of the cortical structures.

Reduction of periodic leg movement in individuals with paraplegia following aerobic physical exercise.

Purpose: According to the American Association of Sleep Disorders, periodic leg movements (PLM) are classified into the group of intrinsic sleep disorders. Studies on PLM in individuals with spinal cord injury are very recent. The objective of the present study was to assess the efficacy of aerobic training in reducing the index/score of PLM in individuals with complete spinal cord injury.Methods: Twelve male volunteers with complete spinal cord injury between T7 and T12 were submitted to six polysonographies (PSG Oxford Medilog SAC system; EEG, EMG and EOG: (1) basal night, (2) 12 h after a maximum effort test, (3) 36 h after a maximum effort test, (4) after 44 days of aerobic physical training, (5) 12 h after the last training session, and (6) 36 h after the last training session. All volunteers participated in a physical training program for 44 days using an arm crank ergometer. Data were analyzed statistically by the Wilcoxon test, with the level of significance set at α5%.Results: The results demonstrated a statistically significant reduction (P⩽0.05) in the comparison of first evaluation (35.1 PLM/h) with fifth (12.70 PLM/h) and sixth evaluation (18.5 PLM/h).Conclusion: This study suggests that a program of regular and systematized physical activity promotes an effective reduction of PLM in individuals with spinal cord injury.

Effect of Acute and Chronic Physical Exercise on Patients with Periodic Leg Movements

PURPOSE Nonpharmacological interventions may lead to an improvement in sleep quality. The objective of our study was to evaluate the effects of acute intensive exercise and chronic exercise on sleep patterns in patients with periodic leg movements (PLM). METHODS The study involved acute and chronic exercise. The acute intensive exercise group consisted of 22 volunteers who underwent a maximum effort test and a polysomnography (PSG) on the same night. The chronic exercise group included 11 patients who performed 72 physical training sessions undergoing three PSG studies on the night of sessions 1, 36, and 72. Blood samples were collected from both acute and chronic groups for beta-endorphin dosage. RESULTS Our results showed that both forms of physical exercise lowered PLM levels. The acute physical exercise increased sleep efficiency, rapid eye movement (REM) sleep, and reduced wake after sleep onset, whereas the chronic physical exercise increased sleep efficiency, REM sleep, and reduced sleep latency. We also found a significant negative correlation between beta-endorphin release after acute intensive exercise and PLM levels (r = -0.63). CONCLUSION Physical exercise may improve sleep patterns and reduce PLM levels. The correlation between beta-endorphin release after acute intensive exercise and PLM levels might be associated with the impact physical exercise has on the opiodergic system. We suggest that physical exercise may be a useful nonpharmacological treatment for PLM.

Sleep Complaints and Polysomnographic Findings: A Study of Nuclear Power Plant Shift Workers

The literature widely recognizes that shift workers have more health complaints than the general population. The objective of this study was to describe the prevalence of sleep complaints and verify the polysomnographic (PSG) variables of shift workers in two Brazilian nuclear power plants. We carried out a subjective evaluation with a sleep questionnaire. Based on these results, the interviewees that reported sleep‐related complaints were referred for polysomnographic evaluation. Of the 327 volunteers initially evaluated by the sleep questionnaire, 113 (35%) reported sleep complaints; they were significantly older, had higher body mass index (BMI), and worked more years on shifts than those without sleep complaints. Of these 113, 90 met criteria for various sleep disorders: 30 (9%) showed obstructive sleep apnea (OSA), 18 (5.5%) showed limb movement, and 42 (13%) evidenced both sleep problems and had a significantly higher proportion of sleep stage 1 and arousals compared with the 23 shift workers that had no indices of sleep problems. The present study found that 90 (27.5%) of the evaluated participants met the PSG criteria of some type of clinical sleep disorder. This high proportion should be investigated for associations with other aspects of work, such as working hours, working schedule, years performing shift work, and access to health services. Due to the strong association between sleep disorders and the incidence of fatigue and sleepiness, the evaluation of the sleep patterns and complaints of shift workers is essential and should be considered to be one of the basic strategies of industry to prevent accidents.

Sleep, ageing and night work

Studies have shown that the frequency or worsening of sleep disorders tends to increase with age and that the ability to perform circadian adjustments tends to decrease in individuals who work the night shift. This condition can cause consequences such as excessive sleepiness, which are often a factor in accidents that occur at work. The present study investigated the effects of age on the daytime and nighttime sleep patterns using polysomnography (PSG) of long-haul bus drivers working fixed night or day shifts. A total of 124 drivers, free of sleep disorders and grouped according to age (<45 years, N = 85, and > or =45 years, N = 39) and PSG timing (daytime (D) PSG, N = 60; nighttime (N) PSG, N = 64) participated in the study. We observed a significant effect of bedtime (D vs N) and found that the length of daytime sleep was shorter [D: <45 years (336.10 +/- 73.75 min) vs N: <45 years (398 +/- 78.79 min) and D: > or =45 years (346.57 +/- 43.17 min) vs N: > or =45 years (386.44 +/- 52.92 min); P < or = 0.05]. Daytime sleep was less efficient compared to nighttime sleep [D: <45 years (78.86 +/- 13.30%) vs N: <45 years (86.45 +/- 9.77%) and D: > or =45 years (79.89 +/- 9.45%) and N: > or =45 years (83.13 +/- 9.13%); P < or = 0.05]. An effect of age was observed for rapid eye movement sleep [D: <45 years (18.05 +/- 6.12%) vs D: > or =45 years (15.48 +/- 7.11%) and N: <45 years (23.88 +/- 6.75%) vs N: > or =45 years (20.77 +/- 5.64%); P < or = 0.05], which was greater in younger drivers. These findings are inconsistent with the notion that older night workers are more adversely affected than younger night workers by the challenge of attempting to rest during the day.

Prevalence of and risk factors for obstructive sleep apnea syndrome in Brazilian railroad workers

OBJECTIVE This study evaluated the prevalence of, and the risk factors for, obstructive sleep apnea syndrome (OSAS) among Brazilian railroad workers. METHODS Male railroad workers (745) from a railway company in Brazil were analyzed after responding to questionnaires about their demographics, sleep habits, excessive daytime sleepiness (Epworth), and the likelihood of having apnea (Berlin). We also performed polysomnography and measured anthropometric data for all of the railroad workers. RESULTS The results showed that 261 (35.03%) of the railroad workers presented with OSAS. These railroad workers were older (OSAS: 38.53±10.08 versus non-OSAS: 33.99±8.92 years), more obese according to body mass index (27.70±4.38 versus 26.22±3.92 kg/m(2)), and employed for a longer period of time (14.32±9.13 years) compared with those without OSAS (10.96±7.66 years). Among those with OSAS, 9.5% were smokers and 54.7% reported alcohol use. The associated risk factors were age (OR=2.51, 95% CI=1.76-3.57), BMI (OR=1.56, 95% CI=1.04-2.34), alcohol use (OR=1.28, 95% CI=0.90-1.81), and a high chance of having sleep apnea, as assessed by the Berlin questionnaire (OR=2.19, 95% CI=1.49-3.21). CONCLUSION The prevalence of OSAS in Brazilian railroad workers was higher than that observed in the general population but similar to that found in the population of the city of São Paulo, Brazil. These results suggest that age, BMI, a high risk of developing apnea through subjective self-reporting (Berlin), and alcohol use are associated with a higher risk of developing OSAS. These data reinforce the need to be more attentive to this population because they have a higher propensity for accidents.